British Rhinological Society Consensus Guidance on the use of biological therapies for Chronic Rhinosinusitis with Nasal Polyps

Abstract

Objectives We set out to create Consensus Guidelines, based on current evidence and relative risks of adverse effects and the costs of different treatments, that reflect the views of the British Rhinological Society (BRS) Council on where the use of biologics should be positioned within treatment pathways for CRSwNP, specifically in the setting of the National Health Service (NHS). Methods An expert panel of 16 members was assembled. A review of the literature and evidence synthesis was undertaken and circulated to the panel We used the RAND/UCLA methodology with a multi-step process to make recommendations on the use of biologics. Setting and participants N/A Results Recommendations were made, based on underlying disease severity, prior treatments and co-morbidities. A group of patients for whom biologics were considered an appropriate treatment option for CRSwNP was defined. Conclusions Although biologics are not currently available for the treatment of CRSwNP, the BRS Council have defined a group of patients who have higher rates of ‘failure’ with current treatment pathways, higher resource use and are more likely to suffer with uncontrolled symptoms. We would urge NICE to consider approval of biologics for such indications without applying further restrictions on use.

Biologicals and Endoscopic Sinus Surgery for Severe Uncontrolled Chronic Rhinosinusitis With Nasal Polyps: An Economic Perspective

“…Because sound data on the cost-effectiveness of biologics in CRS remain missing, a number of organizations, both international and national, have produced consensus guidance on patient selection and an assessment of benefit. 1,4,38,39 There is general agreement that given the preexisting expertise in asthma and the recognition of a global airway, a multidisciplinary approach to severe uncontrolled CRSwNP patients in centers where all treatment modalities are available is advantageous to all concerned, and close collaboration with a pulmonologist and/or allergist is highly recommended, especially because asthma and CRSwNP may both benefit from a particular biologic.…”

“…An assessment of sinus inflammation on computed tomography can also be an inclusion criterion. 38 The need to monitor closely patients who receive these new drugs is implicit in all of the guidelines. Once a regime on a biologic is established, subsequent assessment of the benefit for continuation is proposed on two occasions, although the exact timing of the first evaluation varies (Figures 3 and 4).…”